Common use of SHIP TO INFORMATION Clause in Contracts

SHIP TO INFORMATION. complete if a designated shipping location exists. For multiple locations please attach a facility listing including the phone/fax information and the contact person’s name. By signing this application Applicant agrees to be financially responsible for amounts due and owing to Medline for all invoices and shipments to all of the facilities provided on a facility listing. Business Name GLN MASTER NUMBER Address City St Zip Phone Number Fax Number What portion of your revenue is dependent on Government or State funding such as Medicare, Medicaid, etc. Business Type (Hospital, Nursing Home, Surgery Center, Pharmacy, Laundry, HME Dealer, Internet, etc) If Internet Business, please provide Website Address: Corporation Partnership LLC Limited Partnership Proprietorship Publicly Traded Non Profit # of Employees # of Beds # of Facilities Yrs in Business Owned Property Leased Property Are you part of a buying group? Group Name / Membership # Has Applicant(s), Parent or Business ever filed for Bankruptcy? NO YES (If yes, further information may be required) Are you Accredited? If so, please provide Accrediting Agency and Accreditation #, or attach a copy of Accreditation Certificate. Agency Accreditation # V. MANAGEMENT COMPANY / THIRD PARTY PAYER: Please Complete this section if another organization manages your payments. (Provide listing of managed entities) Company Name(s) Address City St Zip Phone Contact Person Has the applicant had any prior history with Medline, or any of its owners or managers ever operated the same type business? If Yes, Company Name Medline Acct Number Address City St Zip

SHIP TO INFORMATION. complete if a designated shipping location exists. For multiple locations please attach a facility listing including the phone/fax information and the contact person’s name. By signing this application Applicant agrees to be financially responsible for amounts due and owing to Medline for all invoices and shipments to all of the facilities provided on a facility listing. Business Name GLN MASTER NUMBER Address City St Zip Phone Number Fax Number What portion of your revenue is dependent on Government or State funding such as Medicare, Medicaid, etc. Business Type (Hospital, Nursing Home, Surgery Center, Pharmacy, Laundry, HME Dealer, Internet, Scientific Products, etc) If Internet Business, please provide Website Address: Corporation Partnership LLC Limited Partnership Proprietorship Publicly Traded Non Profit # of Employees # of Beds # of Facilities Yrs in Business Owned Property Leased Property Are you part of a buying group? Group Name / Membership # Has Applicant(s), Parent or Business ever filed for Bankruptcy? NO YES (If yes, further information may be required) Are you Accredited? If so, please provide Accrediting Agency and Accreditation #, or attach a copy of Accreditation Certificate. Agency Accreditation # V. MANAGEMENT COMPANY / THIRD PARTY PAYER: Please Complete this section if another organization manages your payments. (Provide listing of managed entities) Company Name(s) Address City St Zip Phone Contact Person Has the applicant had any prior history with Medline, or any of its owners or managers ever operated the same type business? If Yes, Company Name Medline Acct Number Address City St Zip

SHIP TO INFORMATION. complete if a designated shipping location exists. For multiple locations please attach a facility listing including the phone/fax information and the contact person’s name. By signing this application Applicant agrees to be financially responsible for amounts due and owing to Medline for all invoices and shipments to all of the facilities provided on a facility listing. Business Name GLN MASTER NUMBER Address City St Zip Phone Number Fax Number What portion of your revenue is dependent on Government or State funding such as Medicare, Medicaid, etc. Business Type (Hospital, Nursing Home, Surgery Center, Pharmacy, Laundry, HME Dealer, Internet, Scientific Products, Emergency Medical Services, etc.) If Internet Business, please provide Website Address: Corporation Partnership LLC Limited Partnership Proprietorship Publicly Traded Non Profit # of Employees # of Beds # of Facilities Yrs in Business Owned Property Leased Property Are you part of a buying group? Group Name / Membership # Has Applicant(s), Parent or Business ever filed for Bankruptcy? NO YES (If yes, further information may be required) Are you Accredited? If so, please provide Accrediting Agency and Accreditation #, or attach a copy of Accreditation Certificate. Agency Accreditation # V. MANAGEMENT COMPANY / THIRD PARTY PAYER: Please Complete this section if another organization manages your payments. (Provide listing of managed entities) Company Name(s) Address City St Zip Phone Contact Person Has the applicant had any prior history with Medline, or any of its owners or managers ever operated the same type business? If Yes, Company Name Medline Acct Number Address City St Zip

SHIP TO INFORMATION. complete if a designated shipping location exists. For multiple locations please attach a facility listing including the phone/fax information and the contact person’s name. By signing this application Applicant agrees to be financially responsible for amounts due and owing to Medline SML MEDICAL SUPPLIES, INC. for all invoices and shipments to all of the facilities provided on a facility listing. Business Name GLN MASTER NUMBER Address City St Zip Phone Number Fax Number What portion of your revenue is dependent on Government or State funding such as Medicare, Medicaid, etc. Business Type (Hospital, Nursing Home, Surgery Center, Pharmacy, Laundry, HME Dealer, Internet, Scientific Products, etc) If Internet Business, please provide Website Address: Corporation Partnership LLC Limited Partnership Proprietorship Publicly Traded Non Profit # of Employees # of Beds # of Facilities Yrs in Business Owned Property Leased Property Are you part of a buying group? Group Name / Membership # Has Applicant(s), Parent or Business ever filed for Bankruptcy? NO YES (If yes, further information may be required) Are you Accredited? If so, please provide Accrediting Agency and Accreditation #, or attach a copy of Accreditation Certificate. Agency Accreditation # V. MANAGEMENT COMPANY / THIRD PARTY PAYER: Please Complete this section if another organization manages your payments. (Provide listing of managed entities) Company Name(s) ____________________________________________________________________________________ Address City St Zip Phone Contact Person Has the applicant had any prior history with MedlineSML MEDICAL SUPPLIES, INC., or any of its owners or managers ever operated the same type business? If Yes, Company Name Medline SML MEDICAL SUPPLIES, INC. Acct Number Address City St ZipZip TERMS: Per our agreement all Invoices are due 30 days from the invoice date. A finance charge of 2% of the unpaid balance is automatically added to your account if payment is not received on the invoice due date. All claims for defective or damaged goods must be made within four (2) days after receipt of goods. Failure to notify SML MEDICAL SUPPLIES, INC. shall constitute acceptance of work, waiver of defect, damage or shortage. Customer consents to the jurisdiction of any state or federal court in Los Angeles, Orange and San Bernardino County, State of California. Customer will be liable for reasonable costs and legal fees incurred by SML MEDICAL SUPPLIES, INC. Industries or any affiliate thereof to assist in the recovery of any invoices in default. The sales representative assigned to this Customer will negotiate the pricing and terms of this agreement for all orders and all such orders are placed pursuant to such negotiated terms. Any changes in these terms must be negotiated in writing with the assigned sales representative. Any requests for extended payment terms must be approved by SML MEDICAL SUPPLIES, INC. corporate Credit Department. Customer agrees product purchased from SML MEDICAL SUPPLIES, INC. will not be re-sold, distributed, exported or otherwise disposed of contrary to any relevant law or regulation, including but not limited to laws and regulations pertaining to embargoed countries and anti-boycott regulations. Customer further agrees that it shall not resell SML MEDICAL SUPPLIES, INC. brand products to other distributors and retailers for resale purposes, but rather sell the SML MEDICAL SUPPLIES, INC. brand products only to customers for their own use. In the event Customer breaches either of the foregoing obligations, Customer shall pay SML MEDICAL SUPPLIES, INC., as liquidated damages and not as a penalty, 15% of the price of the Products improperly acquired and or/diverted. By signing this agreement, you are also authorizing SML MEDICAL SUPPLIES, INC. to send you advertisements via fax and or email. The applicant’s signature attests the financial responsibility of the undersigned, and that the information and statement in this application are true and correct, and are made for the purpose of including SML MEDICAL SUPPLIES, INC to establish and open line of credit, the payments for which the undersigned agrees to be personally liable, SML MEDICAL SUPPLIES, INC is hereby authorized to obtain an information it considers necessary from any source concerning the statements in this application. The applicant promises to pay for all purchases in accordance with our terms as stated on SML MEDICAL SUPPLIES, INC invoices. The applicant further agrees to notify SML MEDICAL SUPPLIES, INC immediately if the applicant becomes insolvent or otherwise unable to meet current obligations and to pay reasonable attorney or collection fees plus 1.5% interest per month in case if default in payments in compliance with terms. If, at any time, for any reason, the undersigned is unable to pay for purchases when due, the undersigned agrees to pay and authorize SML MEDICAL SUPPLIES, INC to xxxx my / our accounts the maximum legal interest rate on the unpaid balance BY COMPLETING AND RETURNING THIS APPLICATION TO SML MEDICAL SUPPLIES, INC., THE APPLICANT REPRESENTS THAT ALL OF THE INFORMATION CONTAINED IN THIS APPLICATION ARE TRUE AND CORRECT AND APPLICANT AGREES THAT IF ANY OF THE INFORMATION BECOMES OUTDATED OR IF APPLICANT LEARNS OF A POSSIBLE OR PENDING CHANGE IN OWNERSHIP OR MANAGEMENT OF IT OR ANY FACILITY, IT WILL IMMEDIATELY NOTIFY SML MEDICAL SUPPLIES, INC. THE APPLICANT FURTHER AGREES THIS AGREEMENT SHALL BIND APPLICANT’S HEIRS, PERSONAL REPRESENTATIVES, SUCCESSORS AND ASSIGNS AND INURE TO THE BENEFIT OF SML MEDICAL SUPPLIES, INC. THE UNDERSIGNED OR APPLICANT IDENTIFIED AS PROPRIETOR, OWNER, AND OR MAJORITY SHAREHOLDER, AUTHORIZES SML MEDICAL SUPPLIES, INC. TO VERIFY THIS INFORMATION BY OBTAINING DATA FROM A CREDIT REPORTING AGENCY. THE UNDERSIGNED ACKNOWLEDGES THAT HIS OR HER INDIVIDUAL CREDIT HISTORY MAY BE A FACTOR IN THE EVALUATION OF THE CREDIT HISTORY OF THE APPLICANT AND HEREBY CONSENTS AND AUTHORIZES THE USE OF A CONSUMER REPORT ON THE UNDERSIGNED BY SML MEDICAL SUPPLIES, INC. FROM TIME TO TIME, AS SML MEDICAL SUPPLIES, INC. MAY DEEM NECESSARY IN ITS CREDIT EVALUATION. APPLICANT: By: Signature: (Print name) (Principal Owner) Title: Date: Note: Attached Bank Release Authorization form must be completed or Terms will default to Cash In Advance